Healthcare Provider Details

I. General information

NPI: 1821108549
Provider Name (Legal Business Name): BAY STATE PHYSICAL THERAPY OF RANDOLPH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FORGE HILL RD
FRANKLIN MA
02038-3100
US

IV. Provider business mailing address

703 GRANITE ST STE 300
BRAINTREE MA
02184-5350
US

V. Phone/Fax

Practice location:
  • Phone: 508-541-9111
  • Fax: 508-541-7830
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-961-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name: STEVEN WINDWER
Title or Position: CEO
Credential: DC/PT
Phone: 781-961-3370